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Public Policy Priorities to Combat the Opioid and Heroin Epidemic

The expanded availability of prescription painkillers and heroin, known as opioids, has created a public health crisis that demands attention from our government and across our communities nationwide.

As the nation’s leading nonprofit provider of drug and alcohol addiction prevention, treatment and recovery services, the Hazelden Betty Ford Foundation has an important responsibility, and is uniquely qualified, to comment on public policy opportunities that could help reduce the enormous impact of opioid misuse and addiction, which we see every day at our 17 locations across the United States. As such, we are pursuing the following advocacy priorities:

Educate and Prevent

Training for dentists, doctors, nurses and pharmacists
We support the aggressive expansion of education and training for health care providers about the dangers of overprescribing opioids; safe pain management alternatives; screening for, recognizing and monitoring the signs of addiction to alcohol and other drugs; managing risk for addiction and promoting protective factors, just like they do for other highly prevalent and damaging diseases; appropriately intervening when problems are suspected; and referring to specialty care when needed.

Public education
We support national education and prevention campaigns that target youth and their parents, older adults and the general population to dispel myths, provide facts and resources, and reduce stigma. One idea we support is to provide educational literature for consumers, included with their opioid prescriptions. Another would be to add a “penny a pill” or similar surtax to prescription opioids, with proceeds to fund public education campaigns.

School-based preventionOur education systems should develop the capacity to identify adolescents and young adults who engage in any form of substance use—including alcohol and marijuana use—and route them to intervention programs. That starts with providing young people with age-appropriate, evidence-based education and skill-building opportunities while they are still healthy and free from all substances. To protect against later opioid misuse and addiction, prevention must target entire populations; emphasize the relationship between alcohol, cigarette and marijuana use and health problems like addiction, other drug use and death; include robust training for our educators, and start from the earliest years of a child's education, continuing into young adulthood.

Promotion of non-medication pain management therapies
We encourage public and private organizations to embrace healthy approaches to pain management that do not rely so heavily on pain medications. We also urge state medical boards to include diverse pain management guidelines in their policies. A survey we commissioned supports this priority, finding that 80 percent of respondents are willing to reduce or eliminate their current chronic pain medications and try alternatives instead. We are especially supportive of the new opioid prescribing guidelines issued by the Centers for Disease Control and Prevention (CDC) and encourage their implementation nationwide.

Limits on medication
We support legislation, such as measures enacted by Massachusetts, that forbids doctors from writing opioid prescriptions for more than a seven-day supply. Lawmakers in other states are considering similar laws, which would go a long way toward reducing the excess supply in consumers’ medicine cabinets and limiting expectations regarding length of use.

A ban on direct marketing of opioids
The Food and Drug Administration (FDA) should forbid the makers of opioids from marketing them to doctors and the public.

Responsible medication approvals and labeling

We urge the FDA to refrain from approving new high-dosage opiate painkillers, especially those easily crushed and therefore more prone to misuse and diversion, unless the painkillers are clearly safer than existing products.

We also encourage the FDA to further enhance opioid medication labels so that approved uses are appropriately limited and patients are fully aware of the risks and the availability of alternatives. It’s important that consumers understand opioids are addictive drugs that—while useful when taken as prescribed for acute pain—have a similar effect on the mind and body as heroin.

We also believe natural painkillers such as “kratom” should be investigated for possible inclusion on the U.S. Drug Enforcement Administration’s (DEA) controlled drug schedule. Kratom, derived from a plant, has properties of amphetamine and opioids, and is marketed as a “natural painkiller.” It doesn't show up on drug screens, which means people with opioid use disorders can use it without being detected. Those selling it are doing so publicly without consequences, as it remains legal in spite of its addictive qualities. The FDA banned the import of kratom under its authority to keep out substances strongly suspected to be harmful. The DEA has also listed kratom as a “drug of concern” but not a controlled substance. Four states have independently banned it, and the U.S. Army has forbidden its use by soldiers.

Effective Prescription Drug Monitoring Programs (PDMP)

We support establishing a national PDMP and mandating its use by all prescribers
PDMPs help prescribers see what prescriptions their patients may be getting from other prescribers, identifying problematic drug-seeking early on. State-level PDMPs are often voluntary, and the information is usually not shared across state lines. Short of a national system, we encourage more efforts to strengthen state PDMPs, including mandated utilization, appropriate funding and coordination of PDMPs across state lines. Mandated utilization is especially key, since studies show that in states where it is not mandatory, the PDMP is used only a third of the time.

The addition of naloxone revival as an item tracked by PDMPs
We also think prescribers need to know if their patients ever had to be revived from an overdose. A study in the Annals of Internal Medicine found that too many individuals who are revived are then prescribed opioids again.

Effective law enforcement
We support strong sentences for the criminal overprescribing of opioids as well as schemes intended to supply the illegal drug market. We also support closing loopholes in the U.S. postal system to stop dangerous synthetic opioids such as fentanyl and carfentanil from being shipped through our borders to drug traffickers in the U.S.

Real-time surveillance systemsCombatting any public health crisis requires real-time data. Unfortunately, there is typically a two- to three-year lag between when an opioid-related death occurs and when it is published by national data systems. Surveillance of morbidity and mortality empowers decision-makers to understand the effectiveness of policies put in place to combat the opioid crisis, as well as shift or expand resources to manage the problem. Surveillance cannot be used as intended if it is outdated.

Disposal of Unused, Unneeded Medications

We support the U.S. Drug Enforcement Administration’s regulations governing the safe and secure disposal of prescription medications at authorized collection locations. We also support the DEA's National Prescription Drug Take-Back Day and urge communities to vigorously promote their authorized collection locations with other community-wide Prescription Drug Take-Back Days. Such efforts facilitate continued public education about the dangers of keeping excess medications in the home or workplace.

Availability of Overdose “Rescue Drugs”

We encourage expanded access to the opioid antidote naloxone
We also support “Good Samaritan” laws, which encourage people to call 9-1-1 when they witness a drug overdose, without fear of being arrested themselves for drug possession or being under the influence. States such as New York have trained thousands of first responders and lay individuals to recognize and respond to opioid overdoses using naloxone, and many have companion “Good Samaritan” laws. We encourage similar policies nationwide.

Immediate interventionfor people revived from an opioid overdoseWe believe health care providers should adopt a "standard of care," or recommended protocol, for helping people after they have been revived from an opioid overdose with naloxone. Such a standard or protocol would help ensure that overdose survivors are thoroughly evaluated, educated and referred to addiction treatment and/or community-based support resources. Too often people are revived and sent home without further care. They are at extreme risk to use and possibly overdose again. We believe trained peer recovery coaches, integrated into hospital and emergency responder protocols, can play a valuable role in helping overdose survivors make the transition to treatment and recovery support. We also encourage more study of civil commitment laws, which if appropriately circumscribed, could potentially help professionals and family members initiate care for an individual whose life is in immediate danger due to severe opioid addiction.

Accessible Evidence-based Treatment for Opioid Addictions

Longer-term comprehensive care
Research and the experience of our opioid addiction treatment program, Comprehensive Opioid Response with Twelve Steps (COR-12™), show that engaging patients longer, and addressing all forms of substance use as well as mental health concerns, improves the chances for sustained recovery. While the level of care (i.e., residential, intensive outpatient, etc.) is best determined by clinicians using American Society of Addiction Medicine (ASAM) criteria, we support an emphasis on longer-term, comprehensive care. Public funding and insurance policies should support access to the most effective treatments.

Safe, responsible use of medication to assist addiction treatment when appropriate, with abstinence as the long-term goalWe support the use of certain medications in combination with adjunctively with therapy and recovery support to minimize risks and maximize treatment benefits. Our COR-12 program is a model. To that end, we believe primary care doctors who prescribe medications for opioid addiction need to also “prescribe” therapy, regular drug screens and recovery support resources. Current regulations suggest but do not require such measures. At minimum, we’d like to see weekly drug screens and at least one hour of counseling a week required for patients receiving medications for opioid addiction.

In addition, we encourage doctors to consider naltrexone or its extended-release version—Vivitrol—as a viable alternative to Suboxone in some cases, and to consider both of those options as the safest alternatives. To ensure thorough consultations are possible between primary care doctors and their patients with opioid addiction, we also urge that existing limits be maintained on the number of patients to whom a doctor can prescribe Suboxone; at the same time, we would like to see more doctors certified to prescribe the medication.

We know from years of experience that abstinence is a realistic goal for people with opioid addiction, and we urge all professional caregivers to pursue that goal. We also urge that public funding be used to encourage access to the most effective, life-improving treatments.

Access to insurance coverageWe support bipartisan action to retain and improve access to addiction treatment coverage. Any reforms to public and private health insurance policy should include no denial of coverage for those with pre-existing conditions; coverage for young adults on their family health plans through age 26, as addiction starts most often at a young age, when the brain is still developing; continued Medicaid coverage for those who need it; creative solutions to help individuals purchase insurance and help states fill coverage gaps; and the maintenance of substance use coverage, at parity, as an essential health benefit. We also support changing the outdated IMD Exclusion, which limits Medicaid coverage for substance use treatment to facilities with less than 16 beds, to allow coverage for up to 40 treatment beds, or more, at larger facilities.

Parity enforcement to guarantee that insurance companies are not arbitrarily discontinuing coverage for treatment at a certain time
Our organization was at the forefront in supporting the 2008 parity law. We still see “fail-first” violations, though, whereby patients are forced to fail at lower levels of care before receiving the appropriate level of care. The parity provisions also are inconsistently adhered to by insurance companies, something our staff contends with daily. We firmly believe that insurers and other payers should be required to disclose their medical management criteria and how they employ them. The parity regulatory guidance called for under the 21st Century Cures Act on non-quantitative treatment limitations and other issues should be issued as soon as possible.

Addiction care that is integrated with the broader health care system, with support for this chronic condition beyond the acute care stage
When screening, assessment, intervention and care are coordinated between general health systems and specialty addiction treatment programs, both systems benefit, improving effectiveness and efficiency of care and reducing costs. One key to integration is reforming the outdated 42 CFR Part 2 privacy regulations, which have become a barrier to access and deprive patients of the full benefits of modern services. At a minimum, Part 2 requirements should be aligned with the HIPAA requirements that allow the use and disclosure of patient information for treatment, payment and health care operations.

Criminal justice reform
We strongly support the expansion of drug courts and similar sentencing alternatives that are more rehabilitative than punitive and that have been proven to reduce crime, save money, ensure compliance and restore families. We also believe legislative efforts such as the Second Chance Act can help those convicted of drug offenses to get back on their feet through treatment, re-entry programs and employment training. We further support efforts to reform draconian mandatory sentencing laws, restore the voting rights of recovering drug offenders and provide them with more and better sober housing options.

FundingWe need a full-throated, comprehensive public health response to address the current opioid overdose epidemic and a long-term commitment to fighting addiction. We support full funding for the Comprehensive Addiction and Recovery Act, the 21st Century Cures Act and other programs and initiatives essential to addressing this long-neglected public health problem.

Support

Expanded infrastructure for community-based recoveryAddiction is a chronic illness, and we need to think of recovery as we do cancer remission—something that needs close attention and support for up to five years. That doesn’t mean we need five-year-long treatment programs, but rather support mechanisms that help connect recovering people so they can support one another in the community context and be a magnet for others in their community who might seek recovery as well. While recovery often begins with addiction treatment, it is sustained in the community, and people with addiction benefit substantially from long-term recovery engagement. We support grants and targeted efforts to establish recovery community organizations, expand and improve sober housing, and promote collegiate addiction recovery programs and recovery high schools.

Loan forgiveness for licensed addiction counselors who practice in high-need areasThere is a huge need for treatment beds and addiction counselors to staff them, with a projected 31 percent employment growth rate by 2022 for these jobs. In fact, more than 21,000 new counselors will be needed, according to the Bureau of Labor Statistics. We can encourage prospective counselors to go into the field, and fill a need in the country, by offering targeted loan forgiveness for those who commit to practicing in certain high-need areas, for a specified period of time, similar to what’s been implemented for doctors in rural areas, for example. One specific way to do this is to make addiction treatment facilities eligible for the National Health Service Corps (NHSC) student loan repayment and forgiveness program.

Telehealth and other remote supports
We support federal and state legislation that would make it more feasible for health care organizations such as ours to provide care remotely using telehealth technologies. The greatest challenges are obtaining provider licenses across multiple state lines and accessing insurance reimbursements for care delivered in this manner. This is relevant because patients on medication assistance for opioid addiction require continuing care services that support their long-term journey to abstinence, and it is difficult to engage them long term without doing so remotely. Telehealth technologies could also help bring therapy resources to locations where primary care doctors are able to prescribe Suboxone but unequipped to provide follow-up addiction counseling. That is a clear need expressed by participants at our Addiction Medicine for the Primary Care Provider Conferences. Native Americans, military veterans and residents of rural areas, for example, would benefit greatly from greater access to care.

The Opioid Problem: History in the Making

Over the past two decades in the United States, the use of opioids— group of drugs that includes heroin and prescription painkillers—has escalated dramatically, with enormous human and financial costs to individuals, families and communities.

The CDC has described the opioid crisis as the worst drug addiction epidemic in US history.

According to the CDC, deaths related to prescription pain pills have more than quintupled, from 4,030 in 1999 to 20,101 in 2015, while heroin overdose deaths have increased even more, from 1,960 in 1999 to 12,990 in 2015 (33,091 total). All told, during those 17 years, opioid overdoses claimed almost 300,000 lives, including an average of 91 per day (55 to prescription opioids and 36 to heroin) in 2015 alone.

Driven by the rise in opioid deaths, drug overdose has become the leading cause of accidental death in America, with a record 52,404 overdose deaths in 2015 (144 per day). Car accidents, now a distant second, resulted in 38,300 deaths in 2015.

A New York Times analysis published on June 5, 2017, estimated that drug overdose deaths rose an additional 19 percent from 2015 to 2016, possibly the largest annual jump in overdose deaths in U.S. history, and reported that drug overdoses are now the leading cause of death among Americans under the age of 50. Overdose and other substance use-related deaths are also now contributing to reduced life expectancy for many Americans, reversing a decades-long trend toward longer lives.

Indeed, more than 625,000 American lives have been lost to drug overdose since 1999—a staggering total akin to losing the entire city of Portland, Oregon, and roughly the same number of people killed in all battles in the United States’ 240-year history.

Rates of drug overdose death increased for all age groups in 2015; with the largest percentage increase seen for adults ages 55–64. This age group had a fivefold increase in the rates of drug overdose deaths, from 4.2 per 100,000 in 1999 to 21.8 in 2015. Since 2005, rates have been highest for adults ages 45–54.

More than 60 percent of all drug overdose deaths involved an opioid in 2015. And the most common drugs involved in prescription opioid overdose deaths are methadone, oxycodone and hydrocodone.

We’ve also seen a troubling rise in the number of babies born dependent on the opioids their mothers took during pregnancy. At birth, these babies suffer from opioid withdrawal, a condition known as neonatal abstinence syndrome (NAS). From 2000 to 2012, almost 22,000 babies were born with NAS, a five-fold increase since 2000. Sadly, that means one baby is born every 25 minutes suffering from opioid withdrawal.

Not surprisingly, opioid use disorders have also increased dramatically. Of the 20.5 million Americans age 12 or older who had a substance use disorder in 2015, 2 million involved prescription pain relievers and 591,000 involved heroin. Within the Hazelden Betty Ford Foundation’s national system of care, nearly a quarter of our patients are admitted with an opioid use disorder, up 250 percent since 2001. Similarly, Blue Cross and Blue Shield said the number of its members diagnosed with opioid use disorder skyrocketed 493 percent from 2010 to 2016. In yet another barometer of the crisis, Medicaid spending on medications to treat opioid use disorder and opioid overdoses increased from $394 million in 2011 to $928 million in 2016.

Also on the rise: emergency room visits and hospitalizations for opioid-related illnesses, which totaled 1.27 million across the country in 2014 (with women now just as likely as men to be affected), including a 99 percent increase in emergency room visits compared to 2005. In Pennsylvania alone, overdose hospitalizations cost public and private insurers $27 million in 2016.

The total economic burden, including health care costs, of prescription painkillers—never mind heroin and other illicitly sold opioids—has been estimated at $78.5 billion annually.

Costs would be much greater if not for the nationwide deficit in addiction treatment capacity and access. Recent studies estimate that more than 80 percent of people in need of treatment are unable to access needed services, while others resources estimate the gap is as high as 90 percent.

And it’s important to note that people who experience problems using prescription painkillers, heroin and other opioids tend to have other substance use issues as well, and that overdoses typically involve two or three drugs in combination. In addition, most opioid prescriptions go to patients with mental health disorders. All of this highlights the fact that treating opioid use disorders requires comprehensive care addressing addiction to all substances as well as to mental health conditions.

The alarming increases in use, misuse, addiction, overdose deaths and economic costs have closely followed, as one might suspect, a huge increase in the rate of opioid prescriptions and use. The CDC says the amount of prescription opioids sold nearly quadrupled in the U.S. from 1999 to 2014, despite no change in the amount of pain that Americans reported. According to one analysis, about 300 million pain pill prescriptions were written worldwide in 2015, amounting to a $24 billion market. And despite having only 4.6 percent of the world’s population, the U.S. consumes roughly 80 percent of the world’s supply of painkillers, including almost 100 percent of the world’s hydrocodone (e.g., Vicodin).

Some positive news: IMS Health, whose data on prescribing is used widely in health care, found a 12 percent decline in opioid prescriptions nationally since a peak in 2012. IMS further reports that opioid prescriptions have fallen in 49 states since 2013.

Still, opioid prescriptions remain extraordinarily high. Michigan, for example, had more annual opioid prescriptions than people in 2015 and 2016, with 11 million such prescriptions written each year. Blue Cross Blue Shield reported that more than 20 percent of those it insures were prescribed an opioid at least once in 2015. And despite the beginning of a downward trend in prescriptions, opioid-related deaths continue to rise. Increased demand has led to a robust black market for heroin, fentanyl and other opioids that are often combined with each other and/or other drugs to create dangerous drug “cocktails.”

While most prescription opioid users do not go on to use heroin or other illicit opioids, those who are addicted to prescription opioids are 40 times more likely to become addicted to heroin. And multiple studies now indicate that almost 80 percent of new heroin users did previously use prescription opioids. That is consistent with what we hear anecdotally from our young patients who have an opioid use disorder. They often report a relatively swift path from medicine bottle to heroin needle. As prescription supplies dry up and doctor-shopping options run out, heroin becomes the cheaper and more available alternative. A 2014 survey of people in treatment for opioid addiction validated our experience, with 94 percent of respondents saying they used heroin “because prescription opioids were far more expensive and harder to obtain.”

The U.S. now has an estimated 1 million heroin users, and the number of young adult users—those ages 18-25—has more than doubled since 2002, while the number of heroin-related overdose deaths has more than quadrupled, with most of that increase occurring since 2010. Most recently, heroin death rates increased 26 percent from 2013 to 2014, with an additional 21 percent from 2014 to 2015. The rise of synthetic opioids such as fentanyl has exacerbated the crisis, with the death rate from synthetic opioids (other than methadone) increasing by 72 percent from 2014 to 2015.

Opioid problems are now affecting every area of the country, devastating an entire generation in some communities. Hardest hit have been Appalachia and the Rust Belt—including the states of West Virginia, Kentucky, Ohio and Pennsylvania.

The troubling trends of this crisis began to emerge in the late 1990s, after the U.S. Food and Drug Administration (FDA) approved OxyContin and allowed it to be promoted to family doctors for treatment of common aches and pains. Unfortunately, as education campaigns—funded in many ways by opioid manufacturers—exaggerated the benefits and minimized the risks, state policymakers loosened standards governing opioid prescribing. Then, in 2000, the Joint Commission on Accreditation of Healthcare Organizations implemented new pain management standards. Soon, more physicians and organizations began advocating for increased use of opioids to address what, at the time, was perceived to be a widespread problem of undertreated pain. Today, amid this unprecedented public health crisis of opioid addiction and overdose deaths, several states and counties are suing pharmaceutical companies that spent millions on marketing campaigns that “trivialize(d) the risks of opioids while overstating the benefits.”

When prescribed on a short-term basis to treat severe acute pain, opioids can be helpful. In fact, they are one of the best medicines we have. But when these highly addictive medications are taken around-the-clock, for weeks, months and years to treat relatively common conditions, they may actually produce more harm than help. An increasing body of research suggests that for many chronic pain patients, opioids may be neither safe nor effective. Over time, patients often develop tolerance, leading them to require higher and higher doses, which can ultimately lead to quality-of-life issues and functional decline, not to mention addiction. Indeed, the CDC says addiction struggles are experienced by as many as 25 percent of the people who are prescribed opioids long term for non-cancer pain in primary care settings. A more recent analysis, in late 2016, showed that one-third of Americans who had taken prescription opioids for at least two months say they became addicted to or physically dependent on them. And in some cases, opioids can even make pain worse, a phenomenon called hyperalgesia.

Many people associate prescription painkillers with older adults, and that certainly is a significant population affected by the current crisis, with 40 percent of rheumatoid arthritis patients, for example, using opioids regularly. But overdose rates have been highest among people in the middle stages of life (i.e., ages 25–54). Youth are at risk, too, especially with opioids available in the medicine cabinets of so many homes. Young brains are particularly vulnerable because they aren’t fully developed until the mid-20s. Teens may think the drugs are safe because a doctor prescribed them, unaware that pain pills can be as life-threatening as heroin.

The good news is the 2016 Monitoring the Future survey shows that prescription opioid use among teens has declined in recent years. For example, past-year misuse of Vicodin among 12th graders had dropped from 7.5 percent in 2012 to 2.9 percent in 2016. And over those five years, misuse of all prescription opioids dropped 45 percent, from 8.7 to 4.8 percent.

Yet other troubling numbers continue to add up. According to the National Survey on Drug Use and Health, 969,000 adolescents age 12–17 misused prescription pain relievers in 2015, approximately 415,000 adolescents misused pain relievers for the first time in 2015 and an estimated 216,000 had a prescription drug use disorder.

Perhaps most concerning is the ready access that teens have to opioids. In the 2012 National Survey of American Attitudes on Substance Abuse, 34 percent of teenagers reported they could get prescription drugs within a day. And the National Institute on Drug Abuse said 70 percent of 12th graders who used prescription opioids non-medically in 2011 reported obtaining the drugs from a friend or relative, which is the number one source of opioids for non-medical users in most age groups. Our own 2015 survey of nearly 1,200 college-age youth from around the country substantiated these findings, with almost 16 percent of those surveyed reporting they had used pain pills not prescribed to them at some point in their life, while over a third said opioids were “easy to acquire” (most commonly from family and friends) and 37 percent said they did not know where to go for help in the event of an overdose.

Awareness is certainly increasing, partly because prescription drug addiction now affects nearly half of the public on a personal level. A 2016 Kaiser Family Foundation survey found that 44 percent of Americans personally know someone who has been addicted to prescription painkillers, with 26 percent saying the person they know is an acquaintance, 21 percent saying a close friend, 20 percent saying a family member and 2 percent saying themselves.

Doctors are also more aware of the problem although, when it comes to addiction, most are still undereducated through no fault of their own, but due instead to the longtime marginalization of the disease within medical education and mainstream medicine. To be sure, doctors didn’t start overprescribing opioids out of malicious intent but rather out of a desire to treat pain more compassionately. The top reason people visit a physician is pain. As mentioned, doctors were mistakenly informed beginning in the 1990s that treating pain with opioids was safe. Physician visits are now shorter. Non-prescription-related health support services for pain patients have been fragmented and underutilized. Pressure to make decisions and provide quick solutions add to the doctor’s dilemma. Often it is easier for a physician to write a second or third prescription than to ask the difficult question, “Should I change how I am treating this patient?”

We have a culture that now seeks opioid medication for pain relief, perhaps a natural outgrowth of pleasure seeking within a significant percentage of patients who take opiates for pain. In the absence of more holistic self-care approaches, it makes sense that some patients are at significant risk for the development of addiction in our culture, which promotes quick fixes, instant gratification and escapism. But the Hazelden Betty Ford Foundation has learned that recovery from pain conditions—and recovery from pain and addiction—requires far more than taking pills.

Some progress has been made to confront this crisis. Because of new policies to rapidly expand access to the overdose reversal agent naloxone, thousands of people are surviving overdoses and getting another chance to recover from their opioid addiction and reclaim their lives. Federal legislation such as the Comprehensive Addiction and Recovery Act, the 21st Century Cures Act, the Mental Health Parity and Addiction Equity Act, and the Affordable Care Act, have expanded prevention, treatment and law enforcement efforts. And a robust national conversation also has led to more doctors and patients becoming aware of the serious risks associated with opioid pain medications. We were especially enthused to support the new voluntary opioid prescription guidelines issued by the CDC in 2016. We believe the guidelines strike a common-sense balance that will help address overprescribing without stigmatizing pain. We were also pleased to support enhanced warning labels on opioids, which the FDA announced in 2016, about the risks of taking them in combination with other medications known as benzodiazepines.

Unfortunately, the problem is expanding faster than our solutions. Much more needs to be done. This is a crisis that demands our continued attention and commitment.

Learn more and take action to become an advocate for addiction recovery.

The Hazelden Betty Ford Foundation is a force of healing and hope for individuals, families and
communities affected by addiction to alcohol and other drugs. It is the nation's largest
nonprofit treatment provider, with a legacy that began in 1949 and includes the 1982 founding
of the Betty Ford Center. With 17 sites in California, Minnesota, Oregon, Illinois, New York,
Florida, Massachusetts, Colorado and Texas, the Foundation offers prevention and recovery
solutions nationwide and across the entire continuum of care for youth and adults.